We need to talk about Perimenopause more

As I approach my 40th trip around the sun, and many of my friends are around the same age, perimenopause (PM) has become a hot topic. Who would have thought?! Much less taboo these days, but still it is something that women do not have a lot of information about, we definitely do not have a good grasp of, and for a lot of us, we are just flying by the seat of our pants, dealing with each symptom (without much warning) as it arises as best as we can.

As a nutritionist, I love empowering my clients and inspiring them to become curious about their health. I love sharing my knowledge, and helping clients become interested in the drivers behind what is causing their specific symptoms, so that they have a proper understanding of why I am making certain recommendations, be it diet, lifestyle, supplementation, or a combination. Knowing the why, rather than just nodding and smiling (which often comes with underlying resistance) can be so powerful, and can in itself be a tool to use when it comes to setting about and implementing change.

So then, what is it?

Perimenopause (PM) literally means “around menopause” or “around the final period”. As it suggests, “peri” or “around”, does vary greatly from one woman to the next. The median duration for associated symptoms is reported as four years.

The wide array of symptoms common in Western cultures, however, interestingly is not prevalent amongst non-Western cultures, and although menopause is a universally a biological event marking the end of a woman’s reproductive years, the uncomfortable symptoms are most definitely not. The question as to why this is the case remains, however looking at the physiology pertaining particularly to the decline in ovarian function that occurs as women approach their final menses, and the requirement for hormonal and particularly central nervous system support,

Research has confirmed that hormone levels are heavily influenced by how we eat, sleep, move and supplement. Essentially, nourishing our bodies to support our hormones so there are fewer fluctuations, and less variability means we are less likely to have a symptomatic menopause transition. (Freeman et al., 2007).

During PM, as the follicle (from which eggs are released) cohort decreases, a peptide called inhibin B, which is produced by ovarian cells, also declines, resulting in an increase in follicle stimulating hormone (FSH) and a subsequent decline in oestradiol (oestrogen). Although the oestrogen levels can become erratically higher over this time, it is this decline in ovarian function and erratic oestrogen levels which evoke the physiological changes many women report.

A diagnosis of PM is based on symptoms, not blood work!

These symptoms can include (sadly all, but also none!) of the following:

· Hot flashes (particularly annoying at night!)

· Pelvic heaviness

· Heavier periods

· Menstrual cramping

· Mood disturbances (anxiety/anger/rage/depression)

· Difficulty sleeping

· Headaches/migraines

· Low energy

· Weight gain (particularly abdominally)

· Vaginal dryness

· Poor stress management

· Low libido

So what are these hormones that we want to support?

We want our hormones to work for us, not against us!

There is a such a complex interplay of hormones in a woman’s body (her endocrine system), and these not only change throughout each menstrual cycle, but also fluctuate is response to our central nervous system and to our gastro-intestinal system, with the cellular receptors for each hormone responding to biological signalling. External stressors like illness, chronic stress, some medications, poor diet, nutrient deficiencies, lack of movement and excessive alcohol consumption can all disrupt biological pathways, trigger inflammatory responses, interrupt the hormonal secretion and cause hormonal imbalances.

When our bodies are sitting in an equilibrium state aka “homeostasis”, these are the hormones that are secreted into the bloodstream and will travel happily to their target organ or tissue:

· Cortisol

· Insulin

· Thyroid hormone

· Parathyroid hormone

· Adrenaline

· Oestrogen

· Testosterone

· Progesterone

· Follicle stimulating hormone (FSH)

· Luteneizing hormone (LH)

· Prolactin

· Glucagon

· Melatonin

· Oxytocin

· Dehydroepiandrosterone sulfate (DHEA)

· Aldosterone

Why support our nervous system?

While oestrogen declines during perimenopause, as it is actually regulated by serotonin (our “happy neurotransmitter/hormone”), when the serotonin receptors decrease, psychological symptoms and temperature regulation are negatively impacted, eliciting the dreaded mood disturbances and hot flashes.

Supporting our central nervous system is imperative throughout this time, as the nervous system not only affects our serotonin and dopamine levels, but also our production of (and not exclusive to) cortisol (our “fight or flight reflex”), melatonin (our “sleep-wake regulator”), insulin (which maintains normal blood-glucose levels) and adrenaline (provoking stress, heightened awareness).

With the right foods, exercise (you may need to most likely kiss HIIT sessions goodbye for a while, and say hello to brisk walks, meditation, breathwork and yoga!) and supplementation

Although oestrogen levels rise and fall during perimenopause, one hormone also produced by the ovaries that is on a steady decline is progesterone. Infact the decrease in progesterone levels is much more pronounced than any decline in oestrogen. (https://www.nature.com/articles/nrdp201531)

Without progesterone secretion preparing the uterus for pregnancy (progesterone literally means “promoting gestation”), this decline can cause periods to become heavier, more irregular and longer as the uterus sheds the thickened endometrium wall. This decrease is what can also give rise to anxiety, stress and even poor memory function, as progesterone’s metabolite allopregnanolone ceases to be naturally metabolised in the brain tissue. As progesterone is a chemical precursor to cortisol and with prolonged stress lowering its availability, adrenal support during PM is also imperative!

Maintaining optimal weight is crucial during PM, and those women who are overweight (along with those who smoke and those experiencing depression/anxiety) are statistically more likely to experience worsened menopausal symptoms. (https://public-health.uq.edu.au/article/2019/10/what-perimenopause-and-how-does-it-affect-womens-health-midlife)